Provider Demographics
NPI:1255537296
Name:ERICKSON, CAROL JANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JANE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 19TH ST
Mailing Address - Street 2:STE 6
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4307
Mailing Address - Country:US
Mailing Address - Phone:307-637-5808
Mailing Address - Fax:307-432-6775
Practice Address - Street 1:620 W 19TH ST
Practice Address - Street 2:STE 6
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4307
Practice Address - Country:US
Practice Address - Phone:307-637-5808
Practice Address - Fax:307-432-6775
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY303103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY310907OtherBC/BS
WY310907OtherBC/BS